Provider Demographics
NPI:1295355899
Name:GIBSON, ANNA MARIE (RPH, PHARMD, PCOP)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RPH, PHARMD, PCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8954
Mailing Address - Country:US
Mailing Address - Phone:812-426-9733
Mailing Address - Fax:812-842-3879
Practice Address - Street 1:4107 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8954
Practice Address - Country:US
Practice Address - Phone:812-426-9733
Practice Address - Fax:812-842-3879
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0113991835X0200X
IN26019375A1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology